Provider Demographics
NPI:1093044620
Name:RHODES, TIFFANY NICHOLE (RD, LD, CLC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICHOLE
Last Name:RHODES
Suffix:
Gender:F
Credentials:RD, LD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7553 SW 58TH LN APT 315
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4997
Mailing Address - Country:US
Mailing Address - Phone:813-363-8982
Mailing Address - Fax:
Practice Address - Street 1:7553 SW 58TH LN APT 315
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4997
Practice Address - Country:US
Practice Address - Phone:813-363-8982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5651133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered